Healthcare Provider Details

I. General information

NPI: 1417561481
Provider Name (Legal Business Name): ALEXANDRIA COOKE LCMHCA, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2020
Last Update Date: 09/07/2020
Certification Date: 09/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 WAKE FOREST RD STE 200
RALEIGH NC
27609-6859
US

IV. Provider business mailing address

519 ASHLEY CT
CHAPEL HILL NC
27514-1800
US

V. Phone/Fax

Practice location:
  • Phone: 919-865-8818
  • Fax:
Mailing address:
  • Phone: 336-710-4806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA15849
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number424826
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: